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Treatment with Doxycycline of Generalized Annular Elastolytic Giant Cell Granuloma Associated with Borrelia burgdorferi Infection. W INDIAN MED J 2015; 64:447-51. [PMID: 26624605 DOI: 10.7727/wimj.2014.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 11/18/2022]
Abstract
This is a case of generalized annular elastolytic giant cell granuloma (AEGCG) associated with borrelia infection and genes of p-30, p-31, p-39. A possible cross-mediated reaction from the T-cell type which might have induced the AEGCG is discussed from the concept of "heat-shock proteins (HSPs) and molecular mimicry".
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Paul S, Song PI, Ogbechie OA, Sugai DY, Morley KW, Schalock PC, Kroshinsky D. Vesiculobullous and hemorrhagic erythema migrans: uncommon variants of a common disease. Int J Dermatol 2015; 55:e79-82. [PMID: 26498075 DOI: 10.1111/ijd.12927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The diagnosis of Lyme disease relies on the accurate diagnosis of erythema chronicum migrans (ECM) because serologic tests, culture, and polymerase chain reactions are often inaccurate. Although ECM is classically associated with a targetoid rash, there are many variants of this lesion. These variants of ECM are often initially diagnosed as cellulitis or spider bite reactions and treated with oral antibiotics. Inappropriate treatment further delays the diagnosis of Lyme disease, leading to late complications. METHODS We present four cases of vesiculobullous and hemorrhagic ECM, a less common variant of ECM. RESULTS All four patients had a history of exposure to wooded areas in Massachusetts during the summer months. In these patients, ECM presented with central vesicles and bullae with hemorrhage, crusting, and in some cases necrosis. Serologic testing was positive in three of the four cases at presentation. In one case, microscopic examination of a skin biopsy showed epidermal spongiosis with parakeratosis, focal necrosis, papillary dermal edema, erythrocyte extravasation, and a superficial and deep perivascular lymphocytic infiltrate with neutrophils and eosinophils of the dermis. No fungal organisms or bacteria were identified. All four patients were treated with doxycycline with complete resolution of symptoms. CONCLUSIONS It is important to recognize the vesiculobullous and hemorrhagic variants of ECM in order to minimize the provision of inappropriate antibiotic treatment for other diagnoses. Early diagnosis of ECM and the initiation of appropriate antibiotics may prevent late complications of Lyme disease.
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Affiliation(s)
- Suchismita Paul
- Department of Dermatology, Harvard School of Medicine, Boston, MA, USA
| | - Philip I Song
- Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA, USA
| | | | - Daniel Y Sugai
- Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Keith W Morley
- Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Peter C Schalock
- Department of Dermatology, Harvard School of Medicine, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Harvard School of Medicine, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA, USA
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Šmit R, Postma MJ. Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics. Expert Rev Vaccines 2015; 14:1549-61. [DOI: 10.1586/14760584.2015.1091313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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54
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Kempf W, Kazakov DV, Hübscher E, Gugerli O, Gerbig AW, Schmid R, Palmedo G, Kutzner H. Cutaneous borreliosis associated with T cell–predominant infiltrates: A diagnostic challenge. J Am Acad Dermatol 2015; 72:683-9. [DOI: 10.1016/j.jaad.2014.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Abstract
Lyme disease is an Ixodes tick-borne illness that may arise from different species of the Borrelia spirochete and may be propagated in various hosts. Humans are considered dead-end hosts in this propagation cycle but may have a range of Lyme disease characteristics as a result of borrelial infection. Lyme disease has varied cutaneous manifestations, and the approach to diagnosis and treatment is based on the patient, the region, and suspected coinfection with another tick-borne illness. An understanding of the distribution of the Ixodes tick, its vectors, and the most likely dermatologic presentation based on these factors allows the dermatologist to make appropriate testing and treatment recommendations. Our aim is to simplify this approach for the treating practitioner.
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Affiliation(s)
- Desiree A Godar
- Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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56
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Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun 2015; 57:82-115. [DOI: 10.1016/j.jaut.2014.09.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/07/2023]
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Mohanna MT, Kamarashev J, Hofbauer GFL. Borrelial pseudolymphoma of the nose. BMJ Case Rep 2015; 2015:bcr-2014-205688. [PMID: 25568264 DOI: 10.1136/bcr-2014-205688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 52-year-old Colombian woman, a patient with psoriasis, undergoing phototherapy with (ultraviolet B narrowband) UVBnb, presented with a symptomless solitary diffuse erythaematous plaque on her nose for 3 months. Initially, she was treated with pimecrolimus 1% cream for 8 weeks, which was then combined with metronidazole cream for 4 weeks, with the initial diagnosis of UV-triggered rosacea, without improvement. A punch biopsy was performed and the histology showed a pseudolymphomatous reaction. The diagnosis of nasal pseudolymphoma of borreliosis was confirmed with PCR. The lesion completely resolved following oral doxycycline therapy.
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Affiliation(s)
| | - Jivko Kamarashev
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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58
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Tiger JB, Guill MA, Chapman MS. Bullous Lyme disease. J Am Acad Dermatol 2014; 71:e133-4. [PMID: 25219730 DOI: 10.1016/j.jaad.2014.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/08/2014] [Accepted: 04/12/2014] [Indexed: 10/24/2022]
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Infiltration cutanée : une grande galère après 4 biopsies…. Rev Med Interne 2014; 35:686-9. [DOI: 10.1016/j.revmed.2014.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 05/13/2014] [Indexed: 02/07/2023]
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61
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Koçinaj A, Gërçari A, Ferizi M, Lashi E, Gjunkshi L, Fida M. Multiple Erythema Lesions Obscured As Fungal Skin Infection. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Erythema migrans is a ring like erythema, with a few centimeters in diameter. Usually it occur solitary, days to weeks after an infected tick bite. According to skin changes it can be manifested acutely such as erythema migrans in Lyme Borreliosis, borrelial lymphocytoma (subacute), or as a late Lyme disease with acrodermatitis chronica atrophicans. All stages of this disease can be treatable with antimicrobial agents. As a first case in our department with multiple lesions, we describe a 14-year-old female and review the patient’s clinical and laboratory features, the causes of the disease, diagnosis as well as treatment.
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Tijsse-Klasen E, Sprong H, Pandak N. Co-infection of Borrelia burgdorferi sensu lato and Rickettsia species in ticks and in an erythema migrans patient. Parasit Vectors 2013; 6:347. [PMID: 24326096 PMCID: PMC3878868 DOI: 10.1186/1756-3305-6-347] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/05/2013] [Indexed: 12/05/2022] Open
Abstract
Background Lyme borreliosis is the most prevalent tick-borne disease in Europe. Ixodes ricinus also carries other pathogenic bacteria, but corresponding human diseases are rarely reported. Here, we compared the exposure to Rickettsia helvetica and Rickettsia monacensis with that to Lyme borreliosis spirochetes. We assumed that their exposure corresponds to their infection rate in questing I. ricinus. Findings Three Rickettsia species were detected in ticks with a total prevalence of 7.9%, of which the majority was R. helvetica (78%) and R. monacensis (21%). From the same geographic area, skin biopsies of erythema migrans patients were investigated for possible co-infections with Rickettsia spp.. Forty-seven out of 67 skin biopsies were PCR positive for Borrelia burgdorferi s.l. and one sample was positive for R. monacensis. The Borrelia genospecies from the R. monacensis positive patient was identified as Borrelia afzelii. The patient did not show any symptoms associated with rickettsiosis. Conclusions Co-infections of I. ricinus with Rickettsia spp. and B. burgdorferi s.l. were as high as expected from the individual prevalence of both pathogens. Co-infection rate in erythema migrans patients corresponded well with tick infection rates. To our knowledge, this is the first reported co-infection of B. afzelii and R. monacensis.
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Affiliation(s)
- Ellen Tijsse-Klasen
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands.
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63
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Butareva MM, Znamenskaya LF, Muradyan NL, Brezgina OV, Afromeyeva DM. Diagnostics and treatment of erythema chronicum migrans Aftselius Lipschutz in a female patient with localized scleroderma under the condition of daytime hospital. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors describe a case study of the primary stage of the Lyme disease erythema chronicum migrans in a female patient suffering from localized scleroderma. They review principal pathogenetic mechanisms of the onset and potential ethiological relationship between the Lyme disease (borreliosis) and localized scleroderma.
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Brangulis K, Petrovskis I, Kazaks A, Baumanis V, Tars K. Structural characterization of the Borrelia burgdorferi outer surface protein BBA73 implicates dimerization as a functional mechanism. Biochem Biophys Res Commun 2013; 434:848-53. [DOI: 10.1016/j.bbrc.2013.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/02/2013] [Indexed: 11/24/2022]
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Lobular Panniculitis due to Borrelia burgdorferi Infection Mimicking Subcutaneous Panniculitis-Like T-Cell Lymphoma. Am J Dermatopathol 2013; 35:e30-3. [DOI: 10.1097/dad.0b013e31827132cb] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Background: Lyme borreliosis is a multisystemic tick-borne spirochetosis, which may result in dermatologic, musculoskeletal, cardiovascular, and neurologic manifestations. Objective: Patients with suspected acute Lyme borreliosis infection may be referred for urgent dermatologic review. Canadian dermatologists should be aware of the latest information regarding the diagnosis and management of Lyme borreliosis. Methods: This review is based on a PubMed database search combining the word “Lyme” with variations of the word “Canada.” Data sources included articles from the fields of ecology, epidemiology, laboratory diagnostics, and clinical management. Conclusion: In this review, the ecological basis of spirochete transmission by tick vectors is described. The latest available Canadian epidemiologic data are summarized. North American clinical manifestations of Lyme borreliosis are contrasted with European presentations. The Canadian Public Health Laboratory Network's diagnostic guidelines are summarized. Finally, treatment recommendations are outlined.
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Affiliation(s)
- Olivia V. Potok
- From the Division of Dermatology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, and the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB
| | - Alain Brassard
- From the Division of Dermatology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, and the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB
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Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T. Lyme disease: review. Arch Med Sci 2012; 8:978-82. [PMID: 23319969 PMCID: PMC3542482 DOI: 10.5114/aoms.2012.30948] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 07/07/2010] [Indexed: 11/17/2022] Open
Abstract
Lyme disease is a multi-organ animal-borne disease, caused by spirochetes of Borrelia burgdorferi (Bb), which typically affect the skin, nervous system, musculoskeletal system and heart. A history of confirmed exposure to tick bites, typical signs and symptoms of Lyme borreliosis and positive tests for anti-Bb antibodies, are the basis of a diagnosis. A two-step diagnosis is necessary: the first step is based on a high sensitivity ELISA test with positive results confirmed by a more specific Western blot assay. Antibiotic therapy is curative in most cases, but some patients develop chronic symptoms, which do not respond to antibiotics. The aim of this review is to summarize our current knowledge of the symptoms, clinical diagnosis and treatment of Lyme borreliosis.
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Affiliation(s)
- Grażyna Biesiada
- Chair of Gastroenterology, Hepatology and Infectious Diseases, Jagiellonian University Medical College, Krakow, Poland
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69
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70
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Divers T, Grice A, Mohammed H, Glaser A, Wagner B. Changes in Borrelia burgdorferi ELISA antibody over time in both antibiotic treated and untreated horses. Acta Vet Hung 2012; 60:421-9. [PMID: 23160024 DOI: 10.1556/avet.2012.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Changes in ELISA serology are frequently used to determine antibiotic treatment success for Lyme disease in horses. This concept was based upon a previous report showing a marked decline in ELISA values in experimentally infected and antibiotic-treated ponies. Changes in Lyme serology following antibiotic treatment in naturally infected horses have not been reported. The objective of this study was to compare Borrelia ELISA antibody concentrations in naturally exposed horses both before and following antibiotic treatment for Lyme disease. A retrospective study was performed comparing oxytetracycline- or doxycyclinetreated (n = 68) and untreated (n = 183) horses from a single equine practice and their change in Borrelia ELISA values over a similar time period. Antibiotictreated horses had a decline in ELISA values in comparison to control horses (P ≤ 0.05) and untreated horses were twice as likely to have their ELISA values increase (OR = 0.5; 95% C.I. = 0.3-0.9) compared to treated horses. The magnitude of the decline in ELISA units following treatments was small compared to that previously reported in experimentally infected and treated ponies. Field-exposed horses with high Borrelia burgdorferi ELISA values who are treated with either oxytetracycline or doxycycline can be expected to have only a small decline in ELISA values following treatment. Persistently high ELISA titres following appropriate treatments for Lyme disease may not, without appropriate clinical signs, be a reason for more prolonged treatment.
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Affiliation(s)
- Thomas Divers
- 1 Cornell University Department of Clinical Sciences Ithaca NY 14853 USA
| | - Amy Grice
- 3 Rhinebeck Equine 26 Losee Lane Rhinebeck NY USA
| | - Hussni Mohammed
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
| | - Amy Glaser
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
| | - Bettina Wagner
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
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71
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Lindblom A, Wallménius K, Nordberg M, Forsberg P, Eliasson I, Påhlson C, Nilsson K. Seroreactivity for spotted fever rickettsiae and co-infections with other tick-borne agents among habitants in central and southern Sweden. Eur J Clin Microbiol Infect Dis 2012; 32:317-23. [PMID: 22961007 PMCID: PMC3569577 DOI: 10.1007/s10096-012-1742-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/22/2012] [Indexed: 11/08/2022]
Abstract
Patients seeking medical care with erythema migrans or flu-like symptoms after suspected or observed tick bite in the southeast of Sweden and previously investigated for Borrelia spp. and/or Anaplasma sp. were retrospectively examined for serological evidence of rickettsial infection (Study 1). Twenty of 206 patients had IgG and/or IgM antibodies to Rickettsia spp. equal to or higher than the cut-off titre of 1:64. Seven of these 20 patients showed seroconversion indicative of recent or current infection and 13 patients had titres compatible with past infection, of which five patients were judged as probable infection. Of 19 patients with medical records, 11 were positive for Borrelia spp. as well, and for Anaplasma sp., one was judged as positive. Five of the 19 patients had antibodies against all three pathogens. Erythema migrans or rash was observed at all combinations of seroreactivity, with symptoms including fever, muscle pain, headache and respiratory problems. The results were compared by screening an additional 159 patients (Study 2) primarily sampled for the analysis of Borrelia spp. or Mycoplasma pneumoniae. Sixteen of these patients were seroreactive for Rickettsia spp., of which five were judged as recent or current infection. Symptoms of arthritis, fever, cough and rash were predominant. In 80 blood donors without clinical symptoms, approximately 1 % were seroreactive for Rickettsia spp., interpreted as past infection. The study shows that both single and co-infections do occur, which illustrate the complexity in the clinical picture and a need for further studies to fully understand how these patients should best be treated.
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Affiliation(s)
- A Lindblom
- Unit of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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72
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Moniuszko A, Czupryna P, Pancewicz S, Kondrusik M, Penza P, Zajkowska J. Borrelial lymphocytoma—A case report of a pregnant woman. Ticks Tick Borne Dis 2012; 3:257-8. [DOI: 10.1016/j.ttbdis.2012.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/12/2012] [Accepted: 06/16/2012] [Indexed: 10/28/2022]
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Microarray analyses of inflammation response of human dermal fibroblasts to different strains of Borrelia burgdorferi sensu stricto. PLoS One 2012; 7:e40046. [PMID: 22768217 PMCID: PMC3386942 DOI: 10.1371/journal.pone.0040046] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 05/31/2012] [Indexed: 11/19/2022] Open
Abstract
In Lyme borreliosis, the skin is the key site of bacterial inoculation by the infected tick, and of cutaneous manifestations, erythema migrans and acrodermatitis chronica atrophicans. We explored the role of fibroblasts, the resident cells of the dermis, in the development of the disease. Using microarray experiments, we compared the inflammation of fibroblasts induced by three strains of Borrelia burgdorferi sensu stricto isolated from different environments and stages of Lyme disease: N40 (tick), Pbre (erythema migrans) and 1408 (acrodermatitis chronica atrophicans). The three strains exhibited a similar profile of inflammation with strong induction of chemokines (CXCL1 and IL-8) and IL-6 cytokine mainly involved in the chemoattraction of immune cells. Molecules such as TNF-alpha and NF-κB factors, metalloproteinases (MMP-1, -3 and -12) and superoxide dismutase (SOD2), also described in inflammatory and cellular events, were up-regulated. In addition, we showed that tick salivary gland extracts induce a cytotoxic effect on fibroblasts and that OspC, essential in the transmission of Borrelia to the vertebrate host, was not responsible for the secretion of inflammatory molecules by fibroblasts. Tick saliva components could facilitate the early transmission of the disease to the site of injury creating a feeding pit. Later in the development of the disease, Borrelia would intensively multiply in the skin and further disseminate to distant organs.
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Abstract
Lyme borreliosis can affect almost all human organs. Erythema migrans is the first and most frequent manifestation in 80-90% of patients in the early stage of localized skin infection. Besides the typical clinical appearance, many atypical variants can be observed. The solitary borrelial lymphocytoma is much less common and occurs mostly in children. Due to improvement in the early recognition of Lyme borreliosis, the diagnosis is made in the disseminated and late stage in only 10-20% of patients. Multiple erythemata migrantia indicating the hematogenous dissemination of B. burgdorferi remain frequently unrecognized. Late stages of infection feature chronic plasma-cell rich cutaneous inflammation and acrodermatitis chronica atrophicans in its edematous to atrophic forms. Cultivation or DNA detection of B. burgdorferi in skin biopsies are options to prove unusual skin manifestations. Serological detection of Borrelia-specific IgG- and IgM antibodies should be performed according to the two step protocol with ELISA and immunoassay according to the criteria of the MIQ 12. Serological tests have limited utility for follow-up. Antibiotic therapy is very effective if performed according to evidence-based protocols, such as the AWMF guidelines.
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75
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Mayne PJ. Emerging incidence of Lyme borreliosis, babesiosis, bartonellosis, and granulocytic ehrlichiosis in Australia. Int J Gen Med 2011; 4:845-52. [PMID: 22267937 PMCID: PMC3258014 DOI: 10.2147/ijgm.s27336] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Borrelia burgdorferi, the causative agent of Lyme disease (LD), and Babesia, Bartonella, and Ehrlichia species (spp.) are recognized tick-borne pathogens in humans worldwide. Using serology and molecular testing, the incidence of these pathogens was investigated in symptomatic patients from Australia. Methods Sera were analyzed by an immunofluorescent antibody assay (IFA) followed by immunoglobulin (Ig)G and IgM Western blot (WB) assays. Both whole blood and sera were analyzed for detection of specific Borrelia spp. DNA using multiplex polymerase chain reaction (PCR) testing. Simultaneously, patients were tested for Babesia microti, Babesia duncani, Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Bartonella henselae infection by IgG and IgM IFA serology, PCR, and fluorescent in situ hybridization (FISH). Results Most patients reported symptom onset in Australia without recent overseas travel. 28 of 51 (55%) tested positive for LD. Of 41 patients tested for tick-borne coinfections, 13 (32%) were positive for Babesia spp. and nine (22%) were positive for Bartonella spp. Twenty-five patients were tested for Ehrlichia spp. and (16%) were positive for Anaplasma phagocytophilum while none were positive for Ehrlichia chaffeensis. Among the 51 patients tested for LD, 21 (41%) had evidence of more than one tick-borne infection. Positive tests for LD, Babesia duncani, Babesia microti, and Bartonella henselae were demonstrated in an individual who had never left the state of Queensland. Positive testing for these pathogens was found in three others whose movements were restricted to the east coast of Australia. Conclusion The study identified a much larger tick-borne disease (TBD) burden within the Australian community than hitherto reported. In particular, the first cases of endemic human Babesia and Bartonella disease in Australia with coexisting Borrelia infection are described, thus defining current hidden and unrecognized components of TBD and demonstrating local acquisition in patients who have never been abroad.
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Affiliation(s)
- Peter J Mayne
- International Lyme and Associated, Diseases Society, Bethesda, MD, USA.
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Sears KP, Divers TJ, Neff RT, Miller WH, McDonough SP. A case of Borrelia-associated cutaneous pseudolymphoma in a horse. Vet Dermatol 2011; 23:153-6. [PMID: 22029872 DOI: 10.1111/j.1365-3164.2011.01013.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This case report describes a 10-year-old horse that developed multiple dermal papules over the right masseter area following removal of a tick from the same site 3 months earlier. Histological examination of a biopsy from a papule was suggestive of either a T-cell-rich B-cell lymphoma or cutaneous lymphoid hyperplasia, a form of pseudolymphoma sometimes associated with a tick bite. Positive serological testing and PCR of the biopsy sample for Borrelia in conjunction with immunohistochemical testing of the skin biopsy, the clinical history and response to treatment with doxycycline strongly supported the diagnosis of Borrelia-associated cutaneous pseudolymphoma.
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Affiliation(s)
- Kelly P Sears
- Fairfield Equine Associates, 32 Bamabas Road, Newtown, CT 06470, USA
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Ríos-Martín J, Ferrándiz-Pulido L, Moreno-Ramírez D. Aproximación al diagnóstico dermatopatológico de las lesiones figuradas. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:316-24. [DOI: 10.1016/j.ad.2010.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/23/2010] [Accepted: 12/26/2010] [Indexed: 11/26/2022] Open
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Bhate C, Schwartz RA. Lyme disease. J Am Acad Dermatol 2011; 64:639-53; quiz 654, 653. [DOI: 10.1016/j.jaad.2010.03.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/18/2010] [Accepted: 03/03/2010] [Indexed: 12/28/2022]
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79
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Ríos-Martín J, Ferrándiz-Pulido L, Moreno-Ramírez D. Approaches to the Dermatopathologic Diagnosis of Figurate Lesions. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/s1578-2190(11)70814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A, Kristoferitsch W, O'Connell S, Ornstein K, Strle F, Gray J. Lyme borreliosis: Clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect 2011; 17:69-79. [DOI: 10.1111/j.1469-0691.2010.03175.x] [Citation(s) in RCA: 402] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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81
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Affiliation(s)
- Ossama Abbas
- Department of Dermatology, Dermatopathology Section, Boston University School of Medicine, Boston, MA, USA
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Palmen C, Jamblin P, Florkin B, Hoyoux C. Le lymphocytome borrélien du lobe de l’oreille. Arch Pediatr 2010; 17:1159-61. [DOI: 10.1016/j.arcped.2010.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/22/2009] [Accepted: 05/09/2010] [Indexed: 11/25/2022]
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Abstract
Borrelia burgdorferi sensu lato is the causative agent of Lyme borreliosis in humans. This inflammatory disease can affect the skin, the peripheral and central nervous system, the musculoskeletal and cardiovascular system and rarely the eyes. Early stages are directly associated with viable bacteria at the site of inflammation. The pathogen-host interaction is complex and has been elucidated only in part. B. burgdorferi is highly susceptible to antibiotic treatment and the majority of patients profit from this treatment. Some patients develop chronic persistent disease despite repeated antibiotics. Whether this is a sequel of pathogen persistence or a status of chronic auto-inflammation, auto-immunity or a form of fibromyalgia is highly debated. Since vaccination is not available, prevention of a tick bite or chemoprophylaxis is important. If the infection is manifest, then treatment strategies should target not only the pathogen by using antibiotics but also the chronic inflammation by using anti-inflammatory drugs.
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Affiliation(s)
- Hermann J Girschick
- Paediatric Rheumatology, Immunology, Osteology and Infectious Diseases, Children's Hospital, University of Wuerzburg, Josef-Schneider-Str, 2, 97080 Wuerzburg, Germany.
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&NA;. Treatment with antibacterials gets the ‘tick’ when treating skin manifestations of Lyme disease. DRUGS & THERAPY PERSPECTIVES 2009. [DOI: 10.2165/0042310-200925070-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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